Skip to main content
SpringerLink
Log in

Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 14 February 2015

Abstract

Objectives

To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison.

Methods

Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14–54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15–23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18–27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus.

Results

No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively.

Conclusion

Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions.

Key Points

• The used traction technique was well tolerated by most patients.

• The used traction technique almost consistently achieved separation of cartilage layers.

• Traction MR arthrography enabled accurate detection of chondral and labral lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Illustration 1
Illustration 2
Illustration 3
Illustration 4
Illustration 5
Illustration 6
Illustration 7
Illustration 8
Illustration 9
Illustration 10

Similar content being viewed by others

Abbreviations

FAI:

femoroacetabular impingement

FLASH:

fast low-angle shot

FISP:

fast imaging with steady-state precession

LCEA:

lateral centre edge angle

References

  1. Sutter R, Zanetti M, Pfirrmann CWA (2012) New developments in hip imaging. Radiology 264:651–667

    Article  PubMed  Google Scholar 

  2. Smith TO, Hilton G, Toms AP, Donell ST, Hing CB (2011) The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis. Eur Radiol 21:863–874

    Article  PubMed  Google Scholar 

  3. Blankenbaker DG, de Smet AA, Keene JS, Fine JP (2007) Classification and localization of acetabular labral tears. Skelet Radiol 36:391–397

    Article  CAS  Google Scholar 

  4. Sutter R, Zubler V, Hoffmann A, Mamisch-Saupe N, Dora C, Kalberer F, Zanetti M et al (2014) Hip MRI: how useful is intraarticular contrast material for evaluating surgically proven lesions of the labrum and articular cartilage? AJR Am J Roentgenol 202:160–169

    Article  PubMed  Google Scholar 

  5. Pfirrmann CWA, Duc SR, Zanetti M, Dora C, Hodler J (2008) MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology 249:236–241

    Article  PubMed  Google Scholar 

  6. Llopis E, Cerezal L, Kassarjian A, Higueras V, Fernandez E (2008) Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. AJR Am J Roentgenol 190:1124–1128

    Article  PubMed  Google Scholar 

  7. blinded

  8. Tonnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770

    CAS  PubMed  Google Scholar 

  9. Safran MR, Hariri S (2010) Hip arthroscopy assessment tools and outcomes. Oper Tech Orthop 20:264–277

    Article  Google Scholar 

  10. Griffin D, Karthikeyan S (2012) Normal and pathological arthroscopic view in hip arthroscopy. In: Marín-Peña Ó (ed) Femoroacetabular Impingement. Springer, Berlin Heidelberg, pp 113–122

    Chapter  Google Scholar 

  11. Fleiss JL, Levin B, Paik MC (2003) The measurement of interrater agreement. In: Balding DJ (ed) Statistical methods for rates and proportions. John Wiley & Sons, Hoboken New Jersey, pp 599–608

    Chapter  Google Scholar 

  12. Agresti A (2002) Categorical data analysis, 2nd edn. John Wiley & Sons, Hoboken, New Jersey

    Book  Google Scholar 

  13. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  14. Wettstein M, Guntern D, Theumann N (2008) Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. AJR Am J Roentgenol 191:W206–W207, author reply

    Article  PubMed  Google Scholar 

  15. Ng VY, Arora N, Best TM, Pan X, Ellis TJ (2010) Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med 38:2337–2345

    Article  PubMed  Google Scholar 

  16. Saupe N, Zanetti M, Pfirrmann CWA, Wels T, Schwenke C, Hodler J (2009) Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients. Radiology 250:830–838

    Article  PubMed  Google Scholar 

  17. Blankenbaker DG, Ullrick SR, Kijowski R, Davis KW, De Smet AA, Shinki K et al (2011) MR arthrography of the hip: comparison of IDEAL-SPGR volume sequence to standard mr sequences in the detection and grading of cartilage lesions. Radiology 261:863–871

    Article  PubMed  Google Scholar 

  18. Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B (2008) The function of the hip capsular ligaments: a quantitative report. Arthrosc: J Arthrosc Relat Surg 24:188–195

    Article  Google Scholar 

  19. Harris JD, McCormick FM, Abrams GD, Gupta AK, Ellis TJ, Bach BR et al (2013) Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy 29:589–595

    Article  PubMed  Google Scholar 

  20. Toomayan GA, Holman WR, Major NM, Kozlowicz SM, Vail TP (2006) Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol 186:449–453

    Article  PubMed  Google Scholar 

  21. Czerny C, Hofmann S, Urban M, Tschauner C, Neuhold A, Pretterklieber M et al (1999) MR arthrography of the adult acetabular capsular-labral complex: correlation with surgery and anatomy. AJR Am J Roentgenol 173:345–349

    Article  CAS  PubMed  Google Scholar 

  22. Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG (2005) Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy 21:385–393

    Article  PubMed  Google Scholar 

  23. Ziegert AJ, Blankenbaker DG, de Smet AA, Keene JS, Shinki K, Fine JP (2009) Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tear. AJR Am J Roentgenol 192:1397–1400

    Article  PubMed  Google Scholar 

  24. Schmid MR, Nötzli HP, Zanetti M, Wyss TF, Hodler J (2003) Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology 226:382–386

    Article  PubMed  Google Scholar 

  25. Neumann G, Mendicuti AD, Zou KH, Minas T, Coblyn J, Winalski CS et al (2007) Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: evaluation using MR arthrography. Osteoarthr Cartil 15:909–917

    Article  CAS  PubMed  Google Scholar 

  26. Anderson LA, Peters CL, Park BB, Stoddard GJ, Erickson JA, Crim JR (2009) Acetabular cartilage delamination in femoroacetabular impingement. Risk factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am 91:305–313

    Article  PubMed  Google Scholar 

  27. Ellermann J, Ziegler C, Nissi MJ, Goebel R, Hughes J, Benson M et al (2014) Acetabular cartilage assessment in patients with femoroacetabular impingement by using T2* mapping with arthroscopic verification. Radiology 271:512–523

    Article  PubMed  Google Scholar 

  28. Frank LR, Brossmann J, Buxton RB, Resnick D (1997) MR imaging truncation artifacts can create a false laminar appearance in cartilage. AJR Am J Roentgenol 168:547–554

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Ehrenfried Schmaranzer. The authors of this manuscript declare relationships with the following companies: Menges Medical GmBH.The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Florian Schmaranzer, Andrea Klauser & Benjamin Henninger

  2. Department of Radiology, District Hospital St. Johann in Tyrol, Bahnhofstraße 14, 6380, St. Johann in Tyrol, Austria

    Michael Kogler & Ehrenfried Schmaranzer

  3. Department for Applied Systems Research and Statistics, Johannes Keppler University, Altenbergerstraße 69, 4040, Linz, Austria

    Thomas Forstner

  4. Department of Orthopedic Surgery, District Hospital St. Johann in Tyrol, Bahnhofstraße 14, 6380, St. Johann in Tyrol, Austria

    Markus Reichkendler

Authors
  1. Florian Schmaranzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Klauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Kogler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Henninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Forstner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Markus Reichkendler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ehrenfried Schmaranzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Schmaranzer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schmaranzer, F., Klauser, A., Kogler, M. et al. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol 25, 1721–1730 (2015). https://doi.org/10.1007/s00330-014-3534-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3534-x

Keywords

Search

Navigation